A Place to Heal for the Holidays

December 20, 2013

Barbara Corson has struggled with homelessness on and off in recent years, but it seemed a little bit easier to endure with her husband by her side. When she lost him, her life became tougher still. “He died suddenly last March,” Corson recalls. “It was unexpected and we didn’t have any insurance or anything, so that’s when things really began to fall apart for me.”

Unable to turn to family or friends for support, Corson remained in Connecticut’s shelter system as her health began to deteriorate. Ultimately, she landed in the hospital. “They told me I had pneumonia in both lungs,” explains Corson, who is 54. “But once they discharged me, I had nowhere to go. I would have had to go back to a shelter or the street if I had not been able to come here.”

“Here” is the Columbus House Respite Program in New Haven, Conn. It provides care for homeless people discharged from the Yale-New Haven Hospital system who would otherwise end up in a homeless shelter or on the street. In Corson’s case, she will be able to stay through Christmas and New Years and a few weeks after the holiday, while the respite program team helps her find housing. “We opened in October after working four years to gain funding and get started,” says Alison Cunningham, the program’s director. “We knew the community needed the respite center, but it really took Kelly to bring it to life.”

Cunningham is referring to Kelly Doran, MD, MHS, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2011-2013), who, along with Cunningham, helped lead a Respite Task Force that included representatives from Yale-New Haven Hospital, Columbus House, and other community advocates for the homeless.

The idea for the respite program was born from community-based participatory research (CBPR) conducted by Ryan Greysen, MD, MHS, an alumnus of the RWJF Clinical Scholars program (2009-2011), Georgina Lucas, MSW, deputy director of the Clinical Scholars program; and Marjorie S. Rosenthal, MD, MPH, assistant director of the RWJF Clinical Scholars program at the Yale School of Medicine.

The National Need for Respite Care

Having worked with the homeless for 15 years, Doran is uniquely aware of the devastating cycle that entraps many, once they become sick enough to require hospitalization. “People most often cannot rest in shelters [they must leave during the day]. Others are discharged from the hospital and go back onto the street,” Doran says.

To illustrate her point, Doran shares the story of a homeless man whom she met at the Yale-New Haven Hospital’s Emergency Department. “He ended up making 21 ED visits and had 12 hospitalizations over the course of 8 months. After having abdominal surgery, he had no place to rest, take his antibiotics, and take care of the wound. Finally, he was so debilitated; he fell and broke his hip.”

Working with homeless clients of Connecticut’s Columbus House system, local government, federally qualified health centers, and other community members, Greysen’s CBPR team documented the pressing need for respite care for this vulnerable population.

In research partially funded by RWJF and focused on Yale New Haven Hospital (a 1,500-bed facility), they found that 56 percent of patients did not have their housing status addressed during their hospital stay and 11 percent spent their first night after hospital discharge on the streets. A later study led by Doran found a 30-day readmission rate of 51 percent for patients who were homeless when they entered the hospital.

“Our findings led us to conclude that a better solution was needed for patients who were homeless and hospitalized,” Doran adds. “In February 2013, I testified before the Connecticut state senate in support of a bill to start a respite program in New Haven. The legislature eventually voted to commit financial resources to the problem.”

Comfort and Recovery

In offering private rooms, three nutritious meals a day, visiting nurse services, and social services intended to help residents transition into permanent housing, the respite program is much more than just a way to keep people out of shelters or off the streets.

Doran explains, “It offers people at chance to get their medical problems under control, recover from surgery,” or, like Corson, have a fighting chance to beat pneumonia.

With 12 beds, the program is able to at least modestly address the need for respite care in the New Haven area. New Haven is a city of 130,000 people. Many residents endure unemployment and other social and economic challenges. A recent point-in-time count conducted on a winter night found 767 people in the city’s homeless shelters and 20 on the streets. Prior to the Columbus House Respite Program, the city had no facility for homeless people with complex medical needs.

“The number of homeless people in our city is rising,” Cunningham says. “Our situation is a little like New York City because the cost of housing here is tremendously high.”

Doran, who is now an instructor in the departments of Emergency Medicine and Population

Health at NYU School of Medicine/Bellevue Hospital Center, is working with New York State Health Commissioner Nirav Shah, a former RWJF Physician Faculty Scholar (2007-2010) and RWJF Clinical Scholar (2001-2003), on supportive housing for Medicaid patients who are homeless or unstably housed in New York State. Their New England Journal of Medicine Perspectives piece—Housing as Health Care—New York’s Boundary-Crossing Experiment—published on December 19.

Shah and Doran report on New York’s model for supportive housing for the homeless and its role as a health and life-sparing resource that also lowers medical care costs.

No Place like Home

To public health experts, the potentially powerful national impact of respite care for the homeless is a topic for policy debates. But for Barbara Corson, who still struggles to breathe freely, it hits closer to home. “I’m just grateful for this place. The nurses come to see me every day, I have my own room and I love the structure. It’s wonderful to have a roof over my head.”